This is a difficult question to answer. The ankle is a complex joint that forms where three bones come together. The bones of the lower leg, the tibia and the fibula, are above the joint, and the talus is below the joint. When a doctor talks about an ankle fracture, he or she is usually talking about a broken bone of the tibia or fibula.The tibia, also called the shin bone, is the larger, weight-bearing bone of the lower leg. Of the weight transferred through the leg, about 90% is carried by the tibia. The fibula is the smaller bone on the outside of the leg. It only carries about 10% of your body weight.
Both the tibia and the fibula wrap around the talus to form the ankle joint. The bony prominence at the ankle are called the medial malleolus (the end of the tibia) and the lateral malleolus (the end of the fibula). The ends of these bones for a cup for the talus to sit within.
The Broken Ankle
When a broken ankle occurs, the injury may be to the end of the tibia (the medial malleolus) or to the fibula (the lateral malleolus), or both. There are many different type of ankle fractures, and attempting to discuss them is the subject of textbooks, not pamphlets like this. The point is, every ankle fracture MUST be treated individually. You must see your doctor and go over the treatment plan with him or her.There are some general treatment principles of ankle fractures that can be explained here. Common symptoms of an ankle fracture include:
- Pain to touch
- Inability to walk on the leg
- Deformity around the ankle
Once the injury has been determined, a treatment plan is made that is appropriate for the type of ankle fracture. For more information about ankle fracture treatment:
The basic treatments of ankle fractures are described below. Again, anyone with a broken ankle must discuss their individual treatment plan with their doctor, but this outlines some of the basics of ankle fracture treatment:
- Ice and Elevation
Swelling is almost universally seen following a broken ankle. An important part of treatment of an ankle fracture is to minimize swelling. Limiting swelling will help control the pain from the ankle fracture and minimize the damage to the surrounding tissues.
Most patients with an ankle fracture are seen in the doctors office or emergency room. The first step is to obtain X-rays to see what the fracture pattern is, how badly displaced the fracture is, and what the condition of the bone looks like. Depending on the appearance of the ankle fracture on X-ray, treatment decisions can be made.
Splinting an ankle fracture is commonly performed in the emergency room. A splint is often done for a few days, followed by a cast. The splint will allow more room than a cast in case there is continued swelling. If the ankle fracture is not badly displaced, the splint may be put on without moving the broken ankle. If there is displacement, a “reduction” will be performed. After being given anesthesia, the ankle fracture will be re-set to improve the alignment and displacement of the broken bones.
A cast is usually done after a few days, unless the swelling is minimal and it may be done early after the injury. A cast is made either of plaster or fiberglass. Plaster molds to the skin better, and is preferred if the cast is needed to hold the broken bone in a specific place. If the fracture is not unstable, or if some healing has taken place, a fiberglass cast may be used. The fiberglass is lighter weight and more resilient to wear.
Crutches are important, because almost all types of ankle fractures will require some level of immobilization and rest following the injury. Sometime, patients will not be able to place any weight on the ankle for several months, other times within days to weeks. Determining when you can place weight on the broken ankle depends on the type of ankle fracture; this will have to be discussed with your doctor.
Surgery is needed for many types of ankle fractures. While not always necessary, surgery for ankle fractures is not uncommon. The need for surgery depends on the appearance of the ankle joint on X-ray and the type of ankle fracture present. Achieving and maintaining alignment of the broken ankle is of utmost importance. Arthritis is common after an ankle fracture, and the best way to reduce the risk of arthritis is to obtain a normal looking ankle joint. If surgery is needed to achieve this goal, your doctor may recommend an operation